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Pectoralis Major Tendon Ruptures

Key Points

  • The pectoralis major muscle demonstrates two distinctively different parts—the clavicular head and the sternal head.
  • The clavicular head arises from the medial clavicle and upper sternum. It is supplied by the pectoral nerve off of the lateral cord and the deltoid branch of the thoraco-acromial artery.
  • The sternal head arises from the sternum, upper six ribs, and the aponeurosis of the external oblique muscle. It is supplied by the medial pectoral nerve (C8-T1) off of the medial cord.
  • The most common mechanism for sustaining a pectoralis muscle injury is from weight-training or athletics.
  • The patient typically presents after sudden onset of pain in the shoulder. Acutely injured patients have limited shoulder range of motion; however, the more chronic injuries typically have a full range of motion. In more chronic injuries, deformity is obvious with noticeable skin retraction and loss of anterior axillary fold.
  • Imaging of soft-tissue injury in the pectoralis major can be difficult. Plain x-rays can reveal bone avulsions, or loss of pectoralis shadow. Ultrasound can demonstrate intra-muscular injury or loss of continuity of tendon. Hematoma is easily identified in acute injuries.
  • Young, athletic patients will generally not tolerate the persistent weakness and cosmetic deformity that goes with pectoralis major ruptures; however, elderly or low-demand patients with pectoralis ruptures can be treated conservatively with success.
  • The primary goal of surgical repair should be solid tendon apposition to bone.
  • Postoperatively, the arm is placed in a sling. Patients are encouraged to perform limited activities of daily living as tolerated. Gentle ROM exercises begin immediately, avoiding early passive external rotation or abduction.
  • Patients with acutely repaired tendon ruptures may return to full activity 4 to 6 months after repair. Elite weight lifters with chronically repaired tendon ruptures may not be able to return to pre-injury levels.

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